Communication quality shapes the sustainability of pediatric early warning system
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Sara Malone1, Luke Zabotka2, Rebeca Caires3
1Bursky School of Public Health, Washington University in St. Louis, St. Louis, MO, USA. sara.malone@wustl.edu.
Background:
Pediatric early warning systems (PEWS) are quality improvement interventions that reduce preventable mortality during childhood cancer treatment, but sustaining PEWS implementation remains challenging. Although effective team communication has been linked to improved hospital care delivery, its role in supporting long-term PEWS sustainability is not well understood. This study examined the relationship between team communication quality and PEWS sustainability capacity at resource-diverse hospitals providing childhood cancer care.
Methods:
A cross-sectional survey was conducted among clinicians involved in childhood cancer care and PEWS use at 47 hospitals in Latin America and Spain participating in Proyecto EVAT, a quality improvement collaborative focused on PEWS implementation and sustainability. Team communication quality was assessed using the validated CritCom instrument, and sustainability capacity was measured using the Clinical Sustainability Assessment Tool (CSAT). Associations between communication quality and sustainability capacity were evaluated using Spearman's correlation and a linear mixed-effects model accounting for hospital-level clustering.
Results:
A total of 1,288 clinicians participated. Communication quality was positively associated with sustainability capacity (Spearman's ρ = 0.58). In adjusted analyses, each one-unit increase in CritCom score was associated with a 0.50-unit increase in CSAT score (p < 0.001). Physicians and clinicians in PEWS leadership roles reported higher communication quality and sustainability capacity than nurses and non-leadership staff. Respondents working in intensive care and non-clinical settings reported lower sustainability capacity than those working on inpatient wards. Hospital-level characteristics, including funding type and childhood cancer patient volume, were not associated with sustainability capacity.
Conclusions:
Higher-quality team communication independently predicts greater capacity to sustain PEWS across resource-diverse hospitals providing childhood cancer care. Differences by professional role and clinical setting suggest that targeted communication strategies may strengthen the long-term sustainability of evidence-based practices and improve global childhood cancer care outcomes.
